"*" indicates required fields Step 1 of 5 – Business Information 20% Business InformationDate* MM slash DD slash YYYY Business Legal Name* DBA* Business Type*LLCCorporationSole ProprietorshipLimited ProprietorshipLimited Liability ProprietorshipSelect a Business TypeFederal Tax ID OptionalYears in Business*Less than 6 Months1 Year2 Years3 Years4 Years5 Years6 Years7 Years7 + YearsAnnual Revenue*Less than $75,000$75,000 – $100,000$100,000 – $150,000$150,000 – $200,000$200,000 – $250,000$250,000 – $300,000$300,000 – $350,000$350,000 – $400,000$400,000 – $450,000$450,000 – $500,000$500,000 – $550,000$550,000 – $600,000$600,000 – $650,000$650,000 – $700,000$700,000 – $750,000$750,000 – $800,000$800,000 – $850,000$850,000 – $900,000$900,000 – $950,000$950,000 – $1,000,000Over $1,000,000Business Street Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code* Business Phone*Business FaxOptionalWebsite Optional Bank InformationPrimary Bank* Account Number* Bank Phone*Bank Contact* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Equipment InformationGeneral Equipment Description*Equipment Cost*Expected Delivery Date* MM slash DD slash YYYY Vendor InformationBeach Equipment Co. Inc./RAVAmerica, Nick McCullough, Phone: 903-834-3986, 110 Plaza W, Texarkana, TX 75501 Primary Owner/Officer Information% of Ownership* Name* First – As shown on Driver’s License Last Suffix Primary Owner/Officer Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home (Primary) Phone*Cell (Secondary) PhoneEmail* Will there be a Secondary Owner/Officer* Yes No Secondary Owner/Officer Information% of Ownership Name First – As shown on Driver’s License Last Suffix Secondary Owner/Officer Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home (Primary) PhoneCell (Secondary) PhoneEmail Authorization/Disclosure*The above information, together with any accompanying financial statements, schedules, or other materials, is submitted for the purpose of obtaining credit and is warranted to be true, correct and complete. The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his/her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and shall hold Beach Equipment/RAVAmerica or its assignee’s, agents or nominees harmless from same. You understand that such investigation may include seeking information as to the background, credit and financial responsibility of your officers and principals (or any of them). The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicants income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. If for any reason your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial within 60 days from the date you are notified of our decision. To obtain the statement, please write to the lending company within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial of credit within 30 days of receiving your request for the statement. I accept the “Declaration” online credit authorizationSignature* Signature (Secondary Owner/Officer) (Secondary Owner/Officer)CAPTCHAAuthorization How it works; By entering your name, you electronically authorize as specifed in the above document.CommentsThis field is for validation purposes and should be left unchanged.
